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Biomedical subjects

A Verghese

Publications and source records attributed to A Verghese.

At least 55 records · Page 3Linked to original sources
PubMed1993

Rectal histopathology in endemic Shigella and Salmonella diarrhea.

Rectal histopathology was evaluated in 34 cases (2 months-12 yrs old) of endemic "invasive diarrhea" [> 20 WBCs per high-power field on stool microscopy with (RBC positive) or without (RBC negative) associated RBCs] where S. dysenteriae (n = 9), S. flexneri (n = 11), and nontyphoidal Salmonella were isolated as the sole identifiable enteropathogens. Persistent diarrhea (> 14 days duration) was more common with Salmonella infection whereas RBC-positive "invasive diarrhea" was more frequent with Shigella, particularly S. dysenteriae (all cases) infection. The histopathological profile was comparable to the earlier descriptions of infective colitis to a large extent and the nature of the infecting organism could not be determined on the basis of rectal histology alone. The other noteworthy features were as follows: (i) mild crypt distortion (26%) and branching (21%) in both Shigella and Salmonella infection; in Salmonella infection, dilation of the glands was significantly greater with persistent diarrhea; (ii) presence of chronic inflammatory cells either alone or in combination with neutrophils in 62%; a predominant neutrophilic response was significantly higher with S. dysenteriae infection and an acute presentation; (iii) pseudomembrane formation (six subjects; 18%) especially in S. dysenteriae (four cases); and (iv) a significant association of neutrophilic response, edema, and neutrophils within the vessels in the lamina propria and mucin depletion in the glands with RBC-positive "invasive diarrhea."

Ampicillin↗
PubMed1992

Ludwig Traube. The man and his space.

The detection of dullness to percussion in the left hemithorax raises the possibility of pleural effusion, consolidation, or atelectasis. Percussion of Traube's space, a semilunar tympanitic area overlying the gas bubble in the stomach, is a valuable maneuver in this regard: obliteration of Traube's space favors a pleural effusion. Knowledge of the remarkable life of Traube, and the ability to demonstrate the utility of his sign on rounds, provides an opportunity in a technologic age to remind the medical student of the romance of bedside medicine.

Germany↗
PubMed1992

Comparative activity of meropenem (SM-7338) against major respiratory pathogens and amikacin-resistant nosocomial isolates.

Meropenem, a new broad-spectrum carbapenem antibiotic, demonstrated excellent in vitro activity against major respiratory pathogens including Moraxella catarrhalis, Haemophilus influenzae and Streptococcus pneumoniae. Minimal inhibitory concentrations of meropenem for Moraxella catarrhalis and Haemophilus influenzae isolates were frequently less than those of imipenem. For nosocomial amikacin-resistant gram-negative bacilli, meropenem had eightfold lower MIC90 values compared to imipenem against strains of Serratia marcescens, Enterobacter cloacae and Escherichia coli; it was 32-fold more active than imipenem against Proteus mirabilis isolates. Activity was similar to that of imipenem against Pseudomonas aeruginosa isolates. Overall, meropenem showed excellent activity against common community-acquired pathogens as well as amikacin-resistant nosocomial pathogens.

Amikacin↗
PubMed1991

Microvascular architecture of the elastase emphysemic hamster lung.

Vascular corrosion casts of normal and elastase-induced emphysemic hamster lungs, prepared with a low viscosity resin mixture consisting of Mercox and Sevriton, were observed by scanning electron microscopy. Casts were quantitated by measuring vascular volume or determining non-alveolar air space using confocal laser scanning microscopy. Normal lung casts were characterized by well-organized fields of alveoli (about 70 microns in diameter) connected by distinct alveolar ducts. Emphysemic lung casts exhibited numerous bullae (often as large as 0.5 mm in diameter). The vasculature of the bullae indicated that they were formed by destruction of alveolar walls and subsequent coalescence of numerous alveolae. Remnants of alveolar walls, consisting of shallow ridges of capillaries, lined the bases of the bullae. Vascular volumes expressed as cast volume/total tissue volume were calculated at 20% and 12% for uninflated and inflated lungs, respectively, for both control and emphysemic lungs. Four months after elastase instillation, nonalveolar air space of the emphysemic lungs was increased by 73% over controls. These observations indicate that elastase emphysema results, initially, in remodeling of the alveolar structure (bullae formation) and loss of surface area for gas exchange, rather than from extensive loss of vasculature. Vascular corrosion casting is a useful technique for monitoring emphysema both morphologically and quantitatively.

Animals↗
PubMed1991

The use of oral antibiotics in daily clinical practice.

In the treatment of infectious diseases in daily clinical practice, the physician is faced with a wide choice of antibiotics. Rational antibiotic use requires knowledge of the pathogens causing disease at that site, and the prevalence of resistance. In outpatient respiratory tract infection, for example, 3 pathogens, Branhamella (Moraxella) catarrhalis, Haemophilus influenzae and Streptococcus pneumoniae, predominate, beta-Lactamase production by the first 2 is a significant factor in antibiotic selection for respiratory tract infection. Empirical antibiotics are selected for efficacy, cost-effectiveness, safety and patient compliance.

Administration, Oral↗
PubMed1991

Moraxella (Branhamella) catarrhalis.

Moraxella (Branhamella) catarrhalis is now a well-recognized pathogen in lower respiratory tract infections, particularly in the setting of chronic lung disease. The ability to produce beta-lactamase, which now characterizes most clinical strains, appears to be a recently acquired trait. The most common clinical syndrome caused by this organism is exacerbation of chronic bronchitis; this syndrome has been well described in Europe, Japan, and the United States, particularly from centers with a large elderly population with chronic lung disease. The syndrome of pneumonia is less common, and suppurative complications and bacteremia are rare.

Anti-Bacterial Agents↗
PubMed1990

Antibody response to P-protein in patients with Branhamella catarrhalis infections.

Branhamella catarrhalis is now recognized as an important cause of lower respiratory tract infections, especially in the elderly. In most instances, pathogenicity is presumed by recovery of the organism in a sputum culture, a method that is less than conclusive. In order to better diagnose B. catarrhalis infections, an enzyme-linked immunoassay has been developed using P-protein as antigen to measure antibodies to B. catarrhalis. In 17 elderly patients with B. catarrhalis pneumonia and 12 with tracheobronchitis, acute-phase serum antibody titers to P-protein were found to be significantly increased when compared with those of normal subjects (both p less than 0.02). There were no differences in antibody titers between patients with pneumonia and tracheobronchitis. Antibody titers of convalescent-phase sera increased over those of acute-phase sera in 46 percent of pneumonia patients and 50 percent of tracheobronchitis patients. The results demonstrated that lower respiratory tract infections with B. catarrhalis promote a significant elevation in antibody response to P-protein of B. catarrhalis.

Aged↗
PubMed1990

Pulmonary clearance and phagocytic cell response in a murine model of Branhamella catarrhalis infection.

C5-sufficient Swiss-Webster mice (C5+) and C5-deficient DBA/2J mice (C5-) when challenged endotracheally with 2 x 10(7) cfu of Branhamella catarrhalis rapidly clear the lungs of viable bacteria in 48 h. This rapid clearance correlates with a striking influx of polymorphonuclear neutrophils that is of equal magnitude in both C5+ and C5- animals. Supernatant from Todd-Hewitt broth culture of B. catarrhalis exhibits in vivo chemotactic activity in the murine lung and in vitro chemotactic activity in Boyden chambers. The ability of B. catarrhalis to recruit granulocytes, independent of complement, may suggest a role for this organism in promoting protease-mediated lung destruction.

Animals↗
PubMed1990

Randomized comparative study of cefixime versus cephalexin in acute bacterial exacerbations of chronic bronchitis.

Patients with purulent exacerbation of chronic bronchitis were randomized to receive either a single 400-mg daily dose of cefixime or 250 mg of cephalexin, orally, four times a day. Patients were males with a mean age of 63 years. Of the 86 patients, 71 (82%) had bronchitis caused by a single organism (29 by Haemophilus influenzae, 27 by Branhamella catarrhalis, 9 by gram-negative enteric organisms, 6 by Streptococcus pneumoniae), while more than one pathogen was implicated in 15 patients (18%). A total of 70.8% of the cefixime group and 50% of the cephalexin group were clinically cured (chi 2 = 3.89, P less than 0.05); however, when the categories of cured and improved were combined, no significant difference was noted between treatment groups (chi 2 = 3.39, P = 0.06). Analysis of side effects included all 130 evaluable and nonevaluable patients: diarrhea was noted in six patients in the cefixime group and none of the patients in the cephalexin group (P = 0.013 by the Fisher exact test). The diarrhea was mild and self-limited in all cases. B. catarrhalis has emerged as a major cause of exacerbation of bronchitis in our experience; there is an increased need to emphasize the examination of sputum samples by Gram staining if cost-effective antibiotic choices are to be made; any empirically chosen antibiotic should have activity against beta-lactamase-producing strains of B. catarrhalis as well as S. pneumoniae and H. influenzae.

Acute Disease↗
PubMed1990

The harlequin nail. A marker for smoking cessation.

Changes in the human nail frequently serve as an indicator of local and systemic disease. Alterations in the morphology, structure and growth characteristics of the nail accompany chronic cigarette smoking; yellow pigmentation of the nail plate--referred to as the "nicotine sign"--is common. The clubbed yellow nail may indicate the presence of lung cancer. In contrast to the ominous nature of the clubbed yellow nail, we describe a sign that is more propitious: the sudden cessation of smoking due to an intercurrent disease, often a cerebrovascular accident (CVA), leads to the development of a distinct line of demarcation between the distal pigmented nail and the newly emerging proximal nonpigmented nail. We propose the term "harlequin nail" for this curious physical sign. By measurement of the distance between the proximal nail base fold and the line of demarcation, we can deduce the date smoking ceased (and, by inference, the approximate date of a CVA in a patient unable to volunteer this information). This sign also serves as a reminder that the "nicotine nail" remains discolored only because of dynamic restaining of the nail with tobacco by-products.

Aged↗
PubMed1990

Clinical features of pneumonia in the elderly.

Concomitant pneumonia and influenza constitute the leading infectious cause of death in the elderly and the fourth most common cause of death overall. The presence of concomitant illness and delays in diagnosis contribute to significant mortality from this disease in the elderly; senescence of the immune system seems less important in predisposition to pneumonia than the presence of concomitant illness. Delay in diagnosis is frequently secondary to the atypical presentations of pneumonia in the elderly. The usual symptoms of fever, chills, rigors, and sputum production that are present in young adults all may be absent; confusion may be the only presenting symptom. Tachypnea is frequent, but the physical examination, in addition to often being technically difficult, is not sufficiently sensitive in making a diagnosis. Leukocytosis is common, but by no means specific. Chest roentgenograms frequently show incomplete consolidation and findings are difficult to distinguish from other diseases of the elderly, such as congestive heart failure, atelectasis, pulmonary embolism, and malignancy. Therefore, clinical diagnosis requires a high index of suspicion despite atypical clinical manifestations.

Aged↗
PubMed1989

Emerging pathogens in nosocomial pneumonia.

The organisms responsible for nosocomial pneumonia are continuously evolving. Gram-negative bacilli have become the most common etiologic agents over the past 20 years, and with this evolution has come a better understanding of the pathogenesis of gram-negative bacillary pneumonia. Some gram-positive cocci, such as enterococci, group B beta hemolytic streptococci and methicillin-resistant Staphylococcus aureus, haven taken on new significance in nosocomial respiratory infections. Streptococcus pneumoniae, nontypeable Haemophilus influenzae and Branhamella catarrhalis are increasingly reported in hospitalized patients with chronic lung disease. Etiologic agents will change as new antibiotics are introduced. A better understanding of etiologic agents and their pathogens may be the best tool toward preventing hospital-acquired pneumonia.

Cross Infection↗
PubMed1989

The fear of AIDS: psychiatric symptom or syndrome?

The clinical characteristics of 13 patients who presented with the fear of AIDS are documented. The common features included anxiety traits in premorbid personality, a past history of promiscuous heterosexual behaviour, signs and symptoms of an anxiety state. The current controversies regarding the diagnostic status of patients presenting with the fear of AIDS and its clinical significance are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Urbs in rure: human immunodeficiency virus infection in rural Tennessee.

Although the AIDS Commentaries published over the past 18 months have focused on clinical questions relevant to all practicing infectious diseases physicians, they have emphasized clinical information gathered from the large epicenters of the epidemic. We need to remember that clinicians dealing with HIV-infected patients outside metropolitan areas may face problems that are unique. For example, fighting the stigma of AIDS in a low-prevalence population may be as important an issue as treating pneumocystic pneumonia. In this AIDS Commentary, Drs. Abraham Verghese, Steven L. Berk, and Felix Sarubbi of the Veterans Administration Medical Center, East Tennessee State University and describe their experiences in such an environment, discuss some of the problems they've faced, and offer suggestions about what physicians and health officers need to do to prepare for the inevitable spread of AIDS to rural communities.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Secondary adrenal insufficiency manifested as an acute febrile illness.

High fever occurred in a 30-year-old woman five weeks after transsphenoidal hypophysectomy for a pituitary adenoma. Extensive investigation failed to reveal any evidence of infection, and the clinical findings suggested the fever to be a manifestation of steroid withdrawal. Either suboptimal dosage of corticosteroid replacement therapy or omission of such therapy in adrenal insufficiency must be considered in the differential diagnosis of enigmatic postoperative fever.

Acute Disease↗